P.O. Box 5479
Fresno, CA 93755-5479
(559) 432-0222, License # 0E02096, dibu.com
Remit to:
City of Ripon DiBuduo & DeFendis Insurance Brokers, LLC 259 N. Wilma Ave. License # 0E02096
Ripon, CA 95366 PO Box 5479
Fresno, CA 93755-5479
Employment Practices Policy Number: POL095022603 Effective: 7/1/2022 to 7/1/2023 Indian Harbor Insurance
Company
Producer: Kelly Cole-Wilson CSR: Angelica Alvarado
Eff Date Description Amount
07/01/22 Renewal EPL Premium $15,642.00
Carrier Policy Fee (fully earned and taxable): $245.00
CMI Broker Fee (fully earned): $250.00
Surplus Lines Taxes and Fees: $508.36
Total Invoice Balance $16,645.36
Invoice # Page 1 of 1
Account Number Invoice Date
CITYOFR-01 6/08/2022
Balance Due By Amount Due
07/01/22 $16,645.36